The Manufacture of Bodies in Surgery -- Hirschauer

Hirschauer, Stefan. (1991). The Manufacture of Bodies in Surgery. Social Studies of Science 21 (2): 279-319.

In this article, Hirschauer presents an ethnographic study of surgery. Hirschauer uses a thick description to attempt to elucidate surgery as a study in the visibility of the human body in objective form.

Hirschauer begins by a brief analogy of surgical operations and military operations. He focuses on the relations of the forces (an antagonistic one). In the descriptions that follow he describes the surgical arena from the point of view of the various participants. The detailed description of preparation for surgery is intensely detailed and relates not only the patient to the surgeon (the most obvious relationship) but also the surgeon to his/her assistants, the surgeon to the nurses, the nurses to the ‘jumpers’ (basically ‘go-fers’) and the surgeon to the anesthetist. The relationships are examined hierarchically, spatially, and temporally.

The key element of the Hirschauer’s analysis is probably that of visibility. His careful description of the surgery as a focusing of visibility in a particular area to be examined (with the rest of the patient hidden from view) followed by an exploration of the patient’s body in an effort to make visible the particular organ or area of interest is an interesting and important revelation. Hirschauer describes this as ‘targeting’ the area of interest -- the surgeon slices through the skin and then begins cutting and hacking through the body to reveal (make visible) the goal; as Hirschauer explains, "Operating becomes a sequence of looking and cutting, of manipulations providing visibility for further manipulations." (p. 299)

Throughout this process the surgeon compares the patient’s body with the idealized body he/she has studied in school. Since surgeons learn both from books and also from corpses (which do not bleed and are otherwise different from a live body) there is a process of mapping from what the surgeon discovers in the patient’s body to what his/her mind’s eye conceives that body to look like in the ideal. Thus the relationships described above can be extended into the spatial relationships of the patient’s own body. The idealized ‘anatomical’ body models the patient body, but also the reverse is true; the surgeon must learn to balance them and allow them to model each other so as to navigate through the patient body.

Unlike the natural sciences which have been the subject of most ethnographic studies, surgery as an applied science has less room for experimentation. Nevertheless the ‘anatomical body’ is a construction much as other sciences construct facts. In the construction of surgical knowledge there is a tension between the high regard normally present for the human person versus the demands of the ‘will to know’. Hirschauer suggest that the attempt to balance these opposing desires is experienced by ethnographers such as himself just as it is by the surgeons he studied.